Dissociative identity disorder or DID has several relevant concerns that patients and families of patients with the illness should be aware of, one of which is a suicide risk. People with DID are among the highest groups for suicide and suicide attempt. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reported that over 70% of patients with the illness have tried to commit suicide; hence, multiple suicidal attempts are also common. Most of these patients are hesitant to visit their psychiatrist, especially when they are depressed, and so they turn to online therapy for help, which has had varying outcomes.
What are the triggers that push these DID patients to attempt suicide? Why are they so deep down with their depression that they would want to end their life? And can these suicidal thoughts be prevented?
Fact 1. Trauma and abuse during childhood increase the likelihood of suicide in patients with DID.
A lot of studies in the past were performed, and the outcomes have presented evidence of an unquestionable connection between suicide risk and childhood trauma. Constant battering, inappropriate discipline, verbal abuse, and sexual abuse in the past undeniably lead to a tremendously higher risk of suicide when the child becomes an adolescent and adult. Fact is that 90% of individuals with dissociative identity disorder have a history of childhood violence, neglect, and abuse. Thus, it makes sense that suicide risk is quite high. Child abuse plays a very crucial role.
Daniel Reidenberg, PsyD says “We know that when suicide is romanticized or glorified, that too leads to suicide contagion.” Take note that some children have suicidal issues. “Every family’s experience in the days, weeks, and months following a child’s suicide attempt is different,” according to Krystle Herbert, LMFT, PsyD.
Fact 2. There are certain difficulties in evaluating suicide threats in DID.
Complications may arise when evaluating suicide risk in DID patients, especially when various alters emerge. It is because when one personality is suicidal, it doesn’t follow that the rest of the personalities are. In fact, it is possible that the other alters are not aware of the suicidal tendencies of another alter, which is totally true for those who are not co-conscious.
There are also other cases wherein the main person is not at all suicidal, but the other personalities are. In cases like this, the main person may not know that he has an alter who has suicidal behavioral patterns. This situation, referred to as dissociative amnesia, makes it difficult for the DID patient as well as for his therapists and his whole healthcare team. Some doctors have reported having assessed someone with DID in the emergency room, telling them that they can’t stop thinking about killing themselves and that they need help, only to come back after a few minutes talking to a totally new personality who is confused as to why he was even there!
Fact 3. Suicidal alters are common.
In DID systems, suicidal personalities exist, and they emerge as young or old. Yes, there are kid alters that are suicidal. Sometimes, alters that are not originally suicidal can have suicidal thoughts because of devastating flashbacks that can overpower them. In this instance, the alter is unable to control his temper, anxiety, and depression and feels continuously suicidal, which poses a threat to the main person. This is dangerous, as alters that have these patterns may not be able to understand that their behavior impacts the entire system.
Robyn E. Brickel, MA, LMFT suggests “Underestimating the need for suicide prevention is disastrous. Let us make time now to overcome the stigma of talking about mental health.”
Unfortunately, some alters are aware of this yet just don’t care. They want only to wreak havoc on the other personalities, with the goal of destroying the whole system. Attention to this matter is a must. It is vital that there is a team of professionals capable of handling these alters and keeping all of them alive.
Managing Suicidal Threats in Dissociative Identity Disorder
Suicidality is real in DID and managing it is very important. It is rather complicated to deal with because it also involves the alters. It is vital to note that when one part has suicidal ideations, that part should be allowed to be heard and not to be ignored. They should be able to express their feelings and their needs. As a therapist or a member of the healthcare team evaluating the DID patient, you can do this by encouraging a conversation and asking the other ‘relatively good’ parts of the system for help.
As someone who has DID, it is your responsibility to voice out your thoughts to your therapist so that he and the other members of the team can guide you with what to do. In case there are complications that you or your family cannot handle, go to the nearest emergency room. It is for you and your family’s safety. Reach out. It is what’s best for almost anyone who needs help.